Though fractional lasers are widely used for acne scars, very little clinical or histological data based on the objective clinical assessment or the depth of penetration of lasers on in vivo facial tissue are available. The depth probably is the most important aspect that predicts the improvement in acne scars but the studies on histology have little uniformity in terms of substrate (tissue) used, processing and stains used. The variability of the laser setting (dose, pulses and density) makes comparison of the studies difficult. It is easier to compare the end results, histological depth and clinical results. We analysed all the published clinical and histological studies on fractional lasers in acne scars and analysed the data, both clinical and histological, by statistical software to decipher their significance. On statistical analysis, the depth was found to be variable with the 1550-nm lasers achieving a depth of 679 μm versus 10,600 nm (895 μm) and 2940 nm (837 μm) lasers. The mean depth of penetration (in μm) in relation to the energy used, in millijoules (mj), varies depending on the laser studied. This was statistically found to be 12.9-28.5 for Er:glass, 3-54.38 for Er:YAG and 6.28-53.66 for CO 2 . The subjective clinical improvement was a modest 46%. The lack of objective evaluation of clinical improvement and scar-specific assessment with the lack of appropriate in vivo studies is a case for combining conventional modalities like subcision, punch excision and needling with fractional lasers to achieve optimal results.

Hyperpigmentary disorders, especially melasma and post-inflammatory hyperpigmentation (PIH), cause significant social and emotional stress to the patients. Although many treatment modalities have been developed for melasma and PIH, its management still remains a challenge due to its recurrent and refractory nature. With the advent of laser technology, the treatment options have increased especially for dermal or mixed melasma. To review the literature on the use of cutaneous lasers for melasma and PIH. We carried out a PubMed search using following terms "lasers, IPL, melasma, PIH". We cited the use of various lasers to treat melasma and PIH, including Q-switched Nd:YAG, Q-switched alexandrite, pulsed dye laser, and various fractional lasers. We describe the efficacy and safety of these lasers for the treatment of hyperpigmentation. Choosing the appropriate laser and the correct settings is vital in the treatment of melasma. The use of latter should be restricted to cases unresponsive to topical therapy or chemical peels. Appropriate maintenance therapy should be selected to avoid relapse of melasma.

Current standards and recent progress in minimally invasive Phlebo surgery

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Oliver G÷ckeritzDOI:10.4103/0974-2077.99443 PMID:23060705

Venous disorders are among the most frequent disease patterns in the Western world. Still at the turn to the 21st century there was no alternative available to the surgical treatment of varicosis. Meanwhile the endoluminal treatment methods have established and have demonstrated their efficiency while having lower side effects in comparison to the traditional treatment, even though conservatively oriented surgeons are still skeptically eyeing these methods. In the US, according to the latest MRG report of 2011, about 95% of all venous surgeries are already done endoluminally. This paper offers an overview of prevailing treatment standards of the most important endoluminal therapy techniques and shows current trends.

Nose has an important role in the aesthetics of face. It is easy to understand the reason of the major interest that has revolved around the correction of its imperfections for several centuries, or even from the ancient times. In the last decade, all the surgical or medical minimal-invasive techniques evolved exponentially. The techniques of rejuvenation and corrections of nasal imperfections did not escape this development that is much widespread in the medicine of the third millennium. In many cases, the techniques of surgical correction involve invasive procedure that necessitates, for the majority of cases, hospitalisation. The author, using a different approach, has developed mini-invasive techniques using botulinum toxin A (BTxA) and absorbable fillers for the correction of nasal imperfections. BTxA allows to reduce the imperfections due to hypertension of muscles, while the absorbable fillers allow to correct all the imperfections of the nasal profile from the root to the tip in total safety. The correction is based on the precise rules that allow avoiding the majority of side effects. Results are long lasting and well appreciated by patients.

Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.

Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management.
Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG.
Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients.
Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.

Aim: The objective of the present clinical study was to compare the effectiveness of radiofrequency de-epithelialization and conventional (slicing) method in reducing gingival pigmentation on long term basis by split mouth design. Materials and Methods: A total of 28 maxillary gingival units from 4 subjects aged between 15-30 years were considered for this clincal study and the selected gingival units were made plaque free and clinically healthy before subjectiing these sites to one of the procedures. The selected sites were abraded by either the conventional (slicing) method (14 gingival units of 21, 22, 23, 24) or by radiofrequency (14 gingival units of 11, 12, 13, 14). After the procedure periodontal dressing was applied to protect the operated area. After 1 week periodontal dressing was removed and the area was irrigated with saline. Follow up examination was done on 30th, 60th and 90 th days to evaluate the recurrence of pigmentation, if any. Results: It was obsereved that, sites operated with conventional (slicing) method, showed higher mean pigmentation than the sites treated with the radioablation during the follow up period of 90 days. Conclusion: When used judiciously, radiofrequency can be clinically valuable, safe and effective method to reduce pigmentation of gingiva.

Lichen amyloidosis (LA) is a type of primary localized cutaneous amyloidosis clinically characterized by persistent pruritic, hyperkeratotic papules commonly distributed on the shins and histopathologically characterized by amyloid deposits in the papillary dermis. The condition is difficult to treat though various treatment modalities have been tried. We report a case of LA treated successfully with Fractional ablative 2,940 nm Erbium: YAG Laser treatment. To the best of our knowledge, this is the first documented report of the successful use of fractional ablative laser in the treatment of LA.

We describe a case where a secondary traumatic hematoma in a pre-existing palmoplantar wart of the sole was presenting a diagnostic dilemma where it simulated an acral lentiginous melanoma and was managed successfully with wide excision and local skin flap.

We report a case of chemical leucoderma (CL) in a 15-year-old girl, who developed patterned depigmentation at the back of both ear lobules after contact with plastic ear-ring stoppers made of polyvinyl chloride (PVC) after continuous use for 6-7 months. Patch test with Indian standard series and cosmetic series was negative after 48 h, but she refused patch testing for extended duration as the possibility of induced depigmentation at the test site was unacceptable to her. To the best of our knowledge, this is the first report of plastic ear-ring stopper induced CL.

Granuloma faciale (GF) is a chronic condition characterized by red-brown plaques with follicular accentuation present usually on the face. We present a case of 35-year-old female with 5 year history of plaques over cheek and extra facial sites consistent with GF and its response to topical tacrolimus. This case supports previous reports of successful treatment of GF with topical tacrolimus.